3 rd ANNUAL
tate of Womenâ€™s Health S
2018 OUTCOMES REPORT
FROM LIFECYCLE WOMANCARE'S CLINICAL DIRECTOR Thank you to everyone who joined us for #SWH2018, our third annual State of Women’s Health symposium! From Emmy® award winner Anita Woodley’s one-of-a-kind, moving luncheon keynote performance; to the five highly interactive and engaging workshops that focused on critical health priorities facing women, families, and non-binary individuals today; to Deputy Secretary for Health Promotion and Disease Prevention for the Commonwealth of Pennsylvania, Dr. Loren Robinson’s cocktail reception keynote promising state and local government partnership and promotion, it was an inspiring and galvanizing event.
We hope you are as energized as we are to build upon this collaboration. The future of healthcare and equity depends on our collective action. We must never stop working to increase access to innovative, collaborative, and empowering models of care for all. We’ve prepared this outcomes report so that you can continue to be inspired by our speakers and workshops.
The workshops were exceptional, having been created by five teams of healthcare experts. Topics included maternal and child wellness, health disparities, access to care among vulnerable populations, LGBTQ+ literacy and intersectionality, as well as collaborative models of care.
Sincerely, Julie E. Cristol, CNM Clinical Director Lifecycle WomanCare
As the tempo of fall accelerates, we hope that some seeds of connection that took root at the event will come to fruition for you and your organization.
Join the conversation. #SWH2018
THANK YOU TO OUR #SWH2018 SPONSORS AND PARTNERS PRESENTING SPONSORS
Pettaway Pursuit Foundation INNOVATION SPONSORS Keystone First
J.M. Patton Associates, Inc.
Wealth Advisory Group
(Philadelphia University + Jefferson University)
ADVOCACY SPONSORS Lenhardt Rodgers Architecture & Interiors The O’Connor Group/ Blue Gate Consulting
Willig, Williams & Davidson
French International School
Morey, Nee, Buck and Oswald
CONTRIBUTING SPONSOR Managed Care Consultants
SMALL BUSINESS PARTNERS Law Office of Mandy Rosenblum
Christine’s Care and Compassion
Mama Bird Birth Services
Postpartum Stress Center
Placenta Encapsulation Services
Fulheart Family Support
Planned Parenthood Southeastern PA
National Council of Jewish Women, Greater Philadelphia Section
NON PROFIT PARTNERS Drexel University Dornsife School of Public Health, Maternal and Child Health Program Women’s Way Midwifery Institute at Jefferson
Philadelphia Nurse-Family Partnership/ Mabel Morris Family Home Visit Program Lupus Foundation of America, Philadelphia Tri-State Chapter
Chester County Fund for Women & Girls Family Health Initiatives
SWH ADVOCATES Melissa Kamlet
ANITA WOODLEY anitawoodley.com The State of Women’s Health Symposium was a transformative experience for me as a keynote speaker and attendee. Firstly, I'd like to note that as a woman of color, I felt acknowledged, heard, and powerful from the moment that I arrived and long after I departed the symposium. It was an honor to present the conference attendees with adaptable, yet entertaining, alternatives to presentations on women's health to promote good (and prevent harmful) practices to one's overall health. Although my presentation was non-traditional and involved character performances, the audience of mostly professionals was very receptive to the concepts proposed to bring proven positive outcomes to communities through creativity in health education. By bringing diverse presenters as myself, the State of Women’s Health proves yet again to be an event pushing the envelope to highlight today's needs in women's health. As we embark further into the era of health equity for women, it is imperative that conversations are held at events like this. Lifecycle WomanCare showcased a vast number of topics and speakers, of all genders, who gave a full scope of the issues that pertain to women. It is my hope to return to the Philadelphia area to once again engage the community through edu-tainment and bring more attention to this critical topic.
DR. LOREN ROBINSON MD, MSHP, Deputy Secretary for Health Promotion and Disease Prevention for the Commonwealth of Pennsylvania
As the Deputy Secretary of Health and the Women’s Health State Liaison for Region III of the US Health and Human Services, it was my pleasure to share fellowship and promising practices for advancing the health of women at Lifecycle WomanCare’s State of Women’s Health. The health of women across the life course is a public health priority for the Pennsylvania Department of Health. It is imperative that we continue
to work across disciplines to bring improved health and health outcomes for all of our sisters throughout Pennsylvania. Doulas, nurse midwives, nurse practitioners, and physicians, working with team members such as community health workers, social workers, and advocates all make up the true front line addressing these issues. In the field of public health, change often comes in the form of decreased funding or
re-alignment of program priorities and objectives. In times like these, it becomes even more necessary to hear the needs of our patients and our community organizations to find innovative solutions and partnerships. The state and local governments in Pennsylvania stand ready to partner and promote the programs of our stakeholders who are advancing causes of equity in women’s health and reducing both disparity and mortality for women of all ages.
ACCESS TO CARE IN UNPREDICTABLE TIMES: ENSURING HEALTHCARE NEEDS ARE MET AND PROTECTING THOSE MOST VULNERABLE Updates on the status of healthcare coverage and imminent threats at the federal and state levels, impact on vulnerable populations, and actions we can all take to protect and advocate.
Access to care carries many different meanings: • Access to providers. • Access to contraception. • Access to family planning services. • Access to state of the art procedures. • Access to prenatal care. • Access to care that is free from bias and prejudice. This abbreviated list simply outlines the potential barriers that patients may face in Philadelphia and our surrounding communities. Sadly, the concerns we face represent a list that may be duplicated in economically disadvantaged regions around the world. We have strength in numbers. We must capitalize on the energy and opportunity for action that was palpable in our workshop.
care. We learned what legal protections women have gained, and how we must fight to maintain the integrity of these laws. We listened as leaders shared their contingency plans in the event that portions of the ACA are ripped from the spirit of the act. We heard the passion from the students and the senior leaders, and we left empowered to continue to work each day to enhance the lives, and spirits of the patients that we serve.
We heard about a clinic where anyone can access prenatal
-DR. DAVID JASPAN
"There was a call to action in the workshop. People discussed solutions that included voting, staying abreast of laws that affect women’s health BEFORE they become law and calling local, state and national leaders." -SARAH HORVATH
THANK YOU TO OUR FACILITATORS Amal Bass Staff Attorney, Women’s Law Project Marla J Gold MD, Dean Emerita and Professor of Health Management and Policy at the Drexel University School of Public Health Nancy Sharts Hopko PhD, RN, FAAN, ANEF, CNE, Professor in the M. Louise Fitzpatrick College of Nursing at Villanova University
Sarah Horvath Finishing her second year of Family Planning Fellowship at the University of Pennsylvania and is passionate about reproductive rights and justice.
Jack Ludmir MD, Senior Vice President of Physician Engagement and Integration, Associate Provost of Community and Global Initiatives at Jefferson
David Jaspan DO, FACOOG, Chair of the Department of Obstetrics and Gynecology at Einstein Healthcare Network
Michelle Legaspi Sanchez Executive Director of the Chester County Fund for Women and Girls Manan Trivedi MD, MPP, President of the National Physicians Alliance (NPA)
MATERNAL/CHILD WELLNESS: ADDRESSING THE SPECTRUM OF INTER CONCEPTIONAL CARE Addressing the critical importance of strong physical, mental, and environmental care and support for parents and families prior to and in between pregnancies, and innovative and effective programs. It was such a pleasure to be invited to participate in the 2018 State of Women’s Health Symposium. I firmly believe that expanding our perspectives as women’s healthcare providers to view reproductive mental health as relevant across the lifespan positions us to provide optimally impactful and fulfilling care for our clients and patients. Moreover, every opportunity we have to interact, collaborate, and engage in dialogue with providers from varied disciplines elevates our own practices. I am deeply appreciative to Lifecycle WomanCare for providing this experience. I hope to participate again in the future and look forward to doing my part to ensure the growth of this program. Key issues: Maternal mental health, measures we can take toward prevention, providing education to moms and practitioners, eliminating stigma, providing seamless collaborative care across disciplines and across patient lifespan. Implementation: • Collaborative effort (The State of Women's Health Symposium!) • Cross disciplinary training so that practitioners are speaking the same “language” • Sharing of research and best practices between professionals so that we can best address our patients Where we need to focus more attention: Stigma and insufficient psychoeducation both prevent mothers in need of mental health care from advocating for themselves and force them to conceal clinically relevant symptoms. Given the vulnerability that occurs during and immediately following pregnancy and the excellent prognosis for women who receive treatment, I view filling these gaps as absolutely essential.
“Midwives apply an ancient and holistic philosophy to an ever-changing world, making midwifery an exciting and demanding profession.”
-DR. WILLIAM F. MCCOOL
THANK YOU TO OUR FACILITATORS Julie Cristol CNM, Clinical Director at Lifecycle WomanCare Heidi Lengel MMT, MT-BC and Certified Birth and Bereavement Doula CD(SBD) Owner and director of Fulheart Family Support Rachel Mark Staff attorney at the Health, Education, and Legal assistance Project (HELP: MLP) at Widener University
William F. McCool PhD, CNM, FACNM, FAAN, Director of the Midwifery Graduate Program at Penn, Midwifery faculty member at Penn School of Nursing, clinical practice at HUP, Director, Nurse-Midwifery Graduate Program Aasta Mehta MD, MPP, OB Policy Consultant for the Philadelphia Department of Public Health Division of Maternal, Child and Family Health (MCFH)
Theresa Pettaway PCD(DONA), Founder and Executive Director of the Pettaway Pursuit Foundation (PPF) Hilary Waller LPC, Director of Education and Programming and a psychotherapist at The Postpartum Stress Center
THE HARD REALITIES OF HEALTH DISPARITIES: COLLABORATIVE ACTIONS FOR SHIFTING THE PARADIGM Deconstructing the impact of bias and social and environmental determinants of health and equity, and strategizing actions to effect change at all levels: individuals, institutions, and government. Important themes discussed: Access to health services and transportation; using data to inform/improve interventions aimed at reducing health inequities; language barriers; Medicaid coverage for services; cultural competencies/training for providers. Needs in our community that would improve the social determinants of health: Transportation; outreach; easy access to health care and increase quality of care; health education in schools and senior centers; addressing loneliness for seniors; Medicaid to cover family planning services; fair Medicaid reimbursement; access to pre-natal care includes transportation, environment and being valued and respected; funding; grocery stores; awareness; better economic structure; transportation; conversation with people outside of our circles. Policy changes & actions needed that do not currently exist: Legislation passed to address/reduce disparities; more training/using evidence-based, culturally competent information; fair wages; fair work week; Medicaid coverage for family planning; eliminate judicial bypass; increase minimum wage; universal healthcare; gun control laws; educating more providers; represent population being cared for; easier transportation; unstable work weeks/child care/time to see a healthcare provider.
"I think everything is related to environment...I consider it the most key issue and the biggest public health threat. I think the research that shows literacy among girls as a powerful mitigator of climate change is relevant to this work. I would like to see more about the toxic impacts of plastics on women's health." - DR. POUNÉ SABERI
THANK YOU TO OUR FACILITATORS Nelly Jimenez-Arevalo Executive Director and CEO of ACLAMO Family Centers Maeve Kelly Communications and Program Associate at Chester County Fund for Women and Girls (CCFWG)
Pouné Saberi MD, MPH, Board President of the Philadelphia chapter of Physicians for Social Responsibility Brenda Shelton-Dunston MPH, Executive Director of the Black Women’s Health Alliance
WIDENING THE LENS: LGBTQ+ LITERACY AND INTERSECTIONALITY IN HEALTHCARE AND THE WORKPLACE Discussing gender, identity, and orientation in healthcare and the workplace, and providing guidance on how to effectively communicate and train the workforce to be inclusive and welcoming.
Einstein Health Network's Pride Program: Caring for LGBTQ+ Patients -LIBBY PARKER In 2015, Dr. Michele Style, resident physician and cofounder of Einstein Health Network’s Pride Clinic, treated a patient with advanced-stage cervical cancer. Though the patient had health insurance and lived within walking distance of the hospital, she avoided preventative care, including routine Pap smears. During her treatment, the patient disclosed that she identifies as a lesbian and was afraid she would be unfairly judged in a hospital setting because of her sexual orientation. She had avoided pursuing life-saving screenings that could have prevented the progress of her cancer. Unfortunately, her story reflects a much larger trend in healthcare access and outcomes for LGBTQ+ identified individuals.
According to national research, individuals who identify as LGBTQ+ are more likely to experience discrimination in healthcare settings. In a 2010 survey conducted by Lambda Legal, 70% of transgender respondents and almost 56% of lesbian, gay, and bisexual research participants reported experiencing at least one instance of discrimination while trying to access health services.1 In a similar analysis conducted by the National Center for Transgender Equality, in partnership with the National Gay and Lesbian Task Force, 19% of the transidentified respondents described outright denial to health care because of their gender identity. The same survey found that 28% of respondents reported being harassed, while 2% experienced physical violence, during the course of seeking medical care2. Avoiding healthcare settings because of concerns regarding safety, comfort, and acceptance has left a large swath of our population without adequate care. Indeed, Philadelphia estimated that 3.9% of its population3, more than 60,000 people, identify as LGBTQ+, yet competent services and resources for LGBTQ+ are limited. As a result, individuals who identify as LGBTQ+ are more likely to experience adverse health outcomes when compared to their cisgender4, straight peers. When Einstein Healthcare Network launched its LGBTQ+ health initiative and established the Pride Program, its founders
recognized that to provide quality care, staff training would be essential. Though most medical providers are well intended, they are seldom required to educate themselves on the unique experiences of their LGBTQ+ patients, leaving providers without adequate tools to offer the highest quality of compassionate care. The Pride Program has sought to ensure individuals working in LGBTQ+ health care have adequate language by which to communicate with their patients. The Pride Program’s training introduces staff to four essential components of identity: (1) sex assigned at birth, (2) gender identity, (3) gender expression, and (4) sexual orientation. Sex assigned at birth refers to how an individual is categorized at birth, either as male, female, or intersex. It is important to remember that some people may change this later in life, which is why we say “sex assigned at birth” rather than “sex.” Gender identity refers to one’s individual, internal experience of his or her gender. We must be told how another person identifies before we know what his or her gender is. One’s gender identity may vary over time and is not inherently visible to others, as opposed to gender expression. Gender expression is an external manifestation of gender communicated in a variety of ways, including by name, pronoun, clothing, haircut/style, voice, or body characteristics. Society often identifies these cues as masculine and feminine, although this may change over time and varies by culture.
Footnotes 1. From When Health Care Isn’t Caring: Lambda Legal’s Survey of Discrimination Against LGBT People and People with HIV. (New York: Lambda Legal, 2010). Available at https://www.lambdalegal.org/publications/when-health-care-isnt-caring. 2. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey, J.M. Grant, L.A. Mottet, J. Tanis, J. Harrison, J.L. Herman, and M. Keisling, 2011 (Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force), accessed February 4, 2011. 3. The Metro Areas With the Largest, and Smallest, Gay Populations, David Leonhardt, Claire Cain Miller, March 20, 2015, The New York Times, accessed June 1, 2017. 4. Cisgender describes a gender identity in which a person almost always, if not exclusively, identifies as their sex assigned at birth. 5. If you are interested in learning more about terms to avoid, you utilize a variety of resources available online including GLAAD’s publication, ‘An Ally’s Guide to Language’, Available at: https://www.glaad.org/publications/talkingabout/terminology.
Sexual orientation, akin to gender identity, is an internal sense of physical, romantic, and/or emotional attraction to another person. Our sexual orientation is not necessarily visible to others, nor is it inherently static. Though this language is particularly advantageous in working with LGBTQ+ identified individuals, it is important to recognize that all people were assigned a sex at birth, and we all have an internal gender identity and external gender expression in addition to our sexual orientation.
It was a great honor to be among so many committed others, at the recent State of Women's Health Symposium. Co-presenting with Libby Parker, we spoke about Widening the Lens regarding LGBTQ+ people. We were thrilled to have so many enthusiastic participants, from a wide variety of backgrounds, including those who are health care providers, business colleagues and even a representative from a local insurance company, wanting to learn more about being inclusive to all. Our workshop aimed to educate attendees on important terms and experiences of LGBTQ+ people within health care settings and in communities. Topics covering the lifecycle were addressed, from growing up gender non-conforming, to aging as a LGBTQ+ person, to having and raising kids. Our hope was that those who participated left with a desire to learn and do more. Using inclusive language, creating welcoming spaces in health care settings, and beyond, or simply being an ally are all great next steps.
Understanding these four categories helps us better communicate with all our patients regarding essential components of their identity. While there is a great deal of nuanced language specific to these broader categories (including language that is understood to be offensive and should therefore be avoided5), the Pride Program’s training emphasizes the importance of self-determination. By respecting the self-determination of our patients, we recognize that it is our job to listen and remember the patient is always the expert. As care providers, it is up to us to mirror the language used by our patients and not inset our own assumptions into our interactions. We can take steps toward cultivating a more welcoming environment by using gender-neutral language and avoiding language, policies, and practices that exclude our LGBTQ+ identified patients.
THANK YOU TO OUR FACILITATORS Sondra Dantzic Chief Medical Officer, Planned Parenthood Joanne Glusman MSW, LSW, Social Worker at Main Line Health and Co-Chair of the Bryn Mawr Hospital Diversity, Respect and Inclusion Committee Kalen McLean Patient Navigator, Einstein Medical Center Philadelphia’s Pride Program Team
Libby Parker MSS, LSW, Program Manager and Outpatient Therapist, Einstein Health Network’s Pride Program Shoshana Ruskin CRNP, Nurse Practitioner, Lifecycle WomanCare
DON’T FLY SOLO: IMPROVING THE QUALITY OF CARE THROUGH COLLABORATION Exploring why collaborative models of care provide the highest quality of care, satisfaction, and outcomes for patients, providers, and institutions, and how to develop the strongest models possible. What are the key issues that need to be addressed in women’s healthcare today? As I’m sure many would agree, breast cancer is a major issue. The entire process, from detecting the cancer to the developed courses of action, need to be vastly improved. Yes, technology and medicine have had a substantial improvement over time, but the right for a woman, specifically a woman of color, to advocate for herself is not present. This neglect carries over to international women living in the U.S. as well. I feel that if this fact was improved upon, it would make a tremendous difference. Another issue is the hardships women, both of color as well as of a lower socioeconomic status, go through just to give birth in the fashion they would prefer. For instance, if either of these types of women would like to give birth at home, they can face charges or even have their children taken away from them as their environment is seen to foster “neglect” or is not deemed as “acceptable.” A mother should not face consequences based solely on where and how she lives. How can the healthcare community take action in regards to implementing positive change relevant to the specific needs of women? Healthcare personnel should all benefit from the implementation of poverty simulations. This gives each person a chance to view life from a different perspective as they will truly see what it’s like living as the women they serve. While not intentional, many healthcare professionals assume the hardships these women and their families face cease at the resources they provide. However, within my personal experience, it is rarely ever that simple. The course of action I believe should be taken is as follows: • Coordinate multiple poverty simulations to take place over the course of several weeks • Facilitate discussions surrounding the simulation’s impact on each person’s point of view • Develop a specialized team to implement the findings of each professional who participated in the simulation into better programs for women/mothers • Track progress to ensure changes made are effective What areas in women’s healthcare would you like to see receive more attention and why? As this is an area I have been heavily involved in for nearly 20 years, the prenatal sector should be given much more attention. I have witnessed first-hand the positive effect that prenatal support has had on the overall experience of giving birth and being a mother. Circling back to the rights of a mother, these women need to be taken seriously. Just as a woman should be able to give birth using the methods she prefers, that same woman should have the right and access to prenatal resources. A mother, high-risk or not, needs to have the option of having a doula or any type of prenatal assistance she may desire in an effort to make her maternal experience as enjoyable as possible.
THANK YOU TO OUR FACILITATORS Laniece Coleman DNP, CNM, Certified Nurse-Midwife, Assistant Professor and the Chief of the Division of Nursing in the Department of Obstetrics and Gynecology at Drexel University Elena Comber RN, BSN, IBCLC, Nurse Manager at Lifecycle WomanCare Julie Cristol CNM, Clinical Director at Lifecycle WomanCare
Thomas S. Dardarian D.O., Main Line Women’s Health Care Associates, Medical Director at Lifecycle WomanCare Cheung Kim MD, Chief of Obstetrics and Gynecology at Einstein Medical Center Montgomery Theresa Pettaway PCD(DONA), Founder and Executive Director of the Pettaway Pursuit Foundation (PPF)
40 YEARS CELEBRATING
Our doors first opened in 1978, as The Birth Center, and in 1980 we saw our first birth. Since then, LWC has been dedicated to advancing the midwifery model of care.
Join us as we celebrate our past and look forward to the future. LifecycleWomanCare.org
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